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English Translation of TCM
Journal of Chinese Integrative Medicine: Volume 9, 2011   Issue 7
Comparative study on WHO Western Pacific Region and World Federation of Chinese Medicine Societies international standard terminologies on traditional medicine: Syndrome Differentiation of Kidney and Bladder Diseases
Zhao-guo Li (College of Foreign Languages, Shanghai Normal University, Shanghai 200234, China E-mail: zhooushi@163.com)

Received May 20, 2011; accepted May 23, 2011; published online July 15, 2011.
Full-text LinkOut at PubMed. Journal title in PubMed: Zhong Xi Yi Jie He Xue Bao.
    
Correspondence: Zhao-guo Li, MD, Professor; E-mail: zhooushi@163.com; Blog: zhooushi.blog.163.com

  

     The kidneys, located beside the spine and in the waist, are one of the five zang-organs in traditional Chinese medicine (TCM). According to the theory of TCM, the kidneys are the innate foundation of life because they store the innate essence inherited from parents and pertain to water in the five elements.
     The main physiological functions of the kidneys include storing essence, controlling growth, reproduction and water metabolism, and governing the bones and the production of marrow. Physiologically they open into the ears, genitals and anus. In terms of emotions, they are related to terror and fright; in terms of humors, they are related to saliva. Kidney diseases are usually characterized by deficiency, including kidney yang deficiency, kidney yin deficiency, insecurity of kidney qi and failure of the kidneys to receive qi.
     The bladder, located in the center of the lower abdomen, is one of the six fu-organs. The main physiological functions of the bladder include storage and discharge of urine. In the Yellow Emperor’s Canon of Medicine1, the bladder is described as an organ similar to an official in charge of reservoir that discharges urine after transformation of qi. If the bladder is weak in discharging urine, it will cause retention of urine; if the bladder fails to restrain urine, it will cause enuresis. Bladder diseases are usually characterized by frequent urination, urgency of urination, urodynia, dysuria, dripping urination, or even anuria, enuresis and incontinence of urine.
     Since the kidney channel of foot-shaoyin and the bladder channel of foot-taiyang are connected with each other, it is believed that the kidneys and bladder are internally and externally related to each other.
     The following is a brief discussion on the English translation of the names of kidney and bladder diseases included in the WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region2 (abbreviated as the WPRO Standard) and the International Standard Chinese-English Basic Nomenclature of Chinese Medicine compiled by World Federation of Chinese Medicine Societies3 (abbreviated as the WFCMS Standard), according to the studies made in the book entitled International Standardization of English Translation of Traditional Chinese Medicine: Study of Theory, Summarization of Practice and Exploration of Methods4.
     肾膀胱病辨证kidney-bladder diseases pattern identification/syndrome differentiation: visceral pattern identification/syndrome differentiation dealing with diseases of the kidneys and bladder
     To translate肾膀胱病辨证as “kidney-bladder diseases pattern identification/syndrome differentiation” is certainly understandable. However, the structure seems in need of further improvement. If changed into “pattern identification/syndrome differentiation of kidney-bladder diseases”, it may sound more natural.
     肾虚证kidney deficiency pattern/syndrome: any deficiency pattern/syndrome of the kidneys, including deficiency of kidney qi, yin and yang
     肾精不足证kidney essence insufficiency pattern/syndrome: a pattern/syndrome marked by retarded development in children, premature senility, decreased reproductive function, tinnitus, loosening of teeth, loss of hair and forgetfulness in adults
     To translate肾精不足证as “kidney essence insufficiency pattern/syndrome” is almost the same as the original Chinese term in structure. However, if it can be changed into “pattern/syndrome of kidney essence insufficiency”, it may sound structurally natural. By the way, kidney essence insufficiency is a description of the pathological change characterized by retard growth, weakened reproductive function and depletion and deficiency of the blood and kidney essence that lead to failure of the kidneys in storing essence.
     肾气虚证; 肾气亏虚证kidney qi deficiency pattern/syndrome: a pattern/syndrome marked by dizziness, forgetfulness, tinnitus, backache, lack of libido and weak pulse
     In TCM, 肾气虚证and肾气亏虚证are two separate terms, though they are quite similar to each other in structure and meaning. Thus in translation it is quite necessary to translate them separately in order to maintain a regular system of TCM terminologies in English translation. If肾气虚证is translated as “kidney qi deficiency pattern/syndrome”, then肾气亏虚证can be rendered as “kidney qi depletion and deficiency pattern/syndrome” or “pattern/syndrome of kidney qi depletion and deficiency”. The Chinese conception亏虚is composed of two characters, namely, 亏and虚. In the WPRO Standard[2], the Chinese concept亏is translated as “depletion” while虚is rendered as “deficiency”. In order to maintain the lexicological and semantic features of the original Chinese terms or concepts, it is quite advisable to translate亏虚as “depletion and deficiency” or “depletion-deficiency”.
     肾气不固证kidney qi insecurity pattern/syndrome: a pattern/syndrome marked by frequent urination, dribbling of urine after voiding, incontinence of urine or feces, nocturnal emission or premature ejaculation in men, continuous dribbling of menstrual discharge or recurrent spontaneous abortion in women, aching back and knees, and weak pulse
     The Chinese phrase不固in肾气不固证implies weakness of kidney qi. In fact “weakness” is frequently used as the equivalence of不固. However, “weakness” also implies something like “deficiency”. In the current translation of TCM, “weakness” is also quite often used to translate the Chinese concept虚if it mainly refers to physical debilitation. For instance, the Chinese sentence久病必虚can be translated as “prolonged illness will inevitably cause deficiency” if it refers to internal deficiency, or “prolonged illness will inevitably cause weakness” if it refers to physical debilitation. In some English-Chinese dictionaries of TCM, 不固is also translated as “unconsolidation”, sounding like something coined. In the West, some translators like to use “insecurity” to translate不固. At the first sight it sounds quite awkward and does not appear equivalent to不固in Chinese language. In English language “insecurity” means “not safe, not providing good support, cannot be relied on”. In Chinese language, 不固emphasizes the fact that kidney qi is weak in function. To use “insecurity” to translate不固is certainly not an ideal choice. However, it has at least made a distinction between the Chinese concepts不固and虚.
     肾阴虚证; 肾阴亏虚证kidney yin deficiency pattern/syndrome: a pattern/syndrome marked by lumbago, lassitude, dizziness, tinnitus, nocturnal emission in men and oligomenorrhea in women, emaciation, dry throat, thirst, flushed cheeks, hot sensation in the palms and soles, afternoon fever, night sweating, reddened tongue with little or no coating, and rapid fine pulse
     In TCM, 肾阴虚证and肾阴亏虚证are two separate terms, though they are quite similar to each other in meaning and structure just as those of肾气虚证and肾气亏虚证. However, in order to make a distinction between them and maintain a rich terminology of TCM in English translation, it is better to translate them separately. If肾阴虚证is rendered as “kidney yin deficiency pattern/syndrome”, then肾阴亏虚证may be reasonably translated as “kidney yin depletion and deficiency pattern/syndrome” or “pattern/syndrome of kidney yin depletion and deficiency”, as analyzed above in the discuss of肾气虚证and肾气亏虚证. Kidney yin deficiency, or kidney yin depletion and deficiency, similar to kidney yin insufficiency, refers to the pathological change caused by depletion and detriment of yin humor that fails to nourish and moisten the kidney and consequently leads to internal stirring of deficiency-heat or even yin deficiency with effulgent fire.
     肾阴虚火旺证pattern/syndrome of kidney yin deficiency with fire effulgence: a pattern/syndrome marked by tidal fever, night sweating, flushed cheeks, vexing heat in the chest, palms and soles, nocturnal emission, premature jaculation, hypersexuality, lumbar pain, tinnitus, reddened tongue with yellow coating lacking moisture and rapid fine pulse
     The Chinese character旺in the term肾阴虚火旺证is often liberally translated as “hyperactivity” or “exuberance” or “predominance”, all of which tend to be confused with other similar Chinese concepts, such as亢 (hyperactivity or hyperfunction), 盛 (exuberance or flourishing) and胜 (predominance or overwhelming). In the WPRO Standard2, it is rendered as “effulgence”, which, though sounding too literal, at least has made a distinction between 旺and other Chinese concepts like亢, 盛and胜. As a pattern or syndrome, 肾阴虚火旺证is usually caused by deficiency of kidney yin that leads to interior disturbance of deficiency fire. The common clinical manifestations also include night sweating, excessive sexual desire, lumbago and brown urine.
     肾阳虚证; 肾阳亏虚证kidney yang deficiency pattern/syndrome: a pattern/syndrome arising when declined kidney yang fails to warm the body, marked by aversion to cold, cold limbs, listlessness, weakness and soreness of the loins and knees, premature ejaculation or impotence in men and frigidity or infertility in women, nocturia, whitish tongue coating and weak pulse at cubit (chi) section
     Just as analyzed in the discussion about the translations of肾气虚证, 肾气亏虚证and肾阴虚证, 肾阴亏虚证, in TCM, 肾阳虚证and肾阳亏虚证are two separate terms, which, though similar to each other in meaning and structure, still bear certain subtle difference if careful analysis is made. For the sake of systematic and comprehensive transference of information in translating TCM literature, it is better to translate these terms separately rather than identically. If肾阳虚证is rendered as “kidney yang deficiency pattern/syndrome”, then 肾阳亏虚证may be reasonably translated as “kidney yang depletion and deficiency pattern/syndrome” or “pattern/syndrome of kidney yin depletion and deficiency”, as analyzed above in discussing the translation of other TCM paired terms.
     肾不纳气证pattern/syndrome of kidney failing to receive qi: a pattern/syndrome marked by dyspnea with prolonged exhalation, asthenic cough and feeble voice
     The so-called纳气is one of the basic physiological functions of the kidney. According to the theory of TCM, the kidneys govern qi reception (肾主纳气), which means that the kidneys receive the fresh air inhaled by the lung to maintain normal respiratory function of the body. The lung is the dominator of qi while the kidneys are the root of qi. The lung is responsible for exhaling qi while the kidneys are in charge of receiving qi. Such an interaction between the lung and the kidneys ensures normal and smooth respiration. This shows that the depth of respiration depends on the function of the kidneys. If the kidneys function normally, respiration will be conducted normally. If the kidneys do not function well, it may cause shallow breath. Such a disorder of breath is known as “failure of the kidney to receive qi”, which is a pathological change characterized by ascendant counterflow of lung qi due to hypofunction of lung qi in reception caused by deficiency and detriment of kidney qi, usually caused by qi deficiency in the lung and kidneys that leads to the failure of the kidneys to receive qi. The common clinical manifestations of such a disorder include more expiration and less inspiration, weak cough, aggravation with exertion, clear thin sputum, low voice, spontaneous sweating, urination with cough, light-colored purplish tongue, weak pulse.
     肾虚水泛证pattern/syndrome of kidney deficiency with water flood: a pattern/syndrome arising when insufficient kidney qi fails in qi transformation and leads to water flooding, marked by edema, particularly of the lower extremities, accompanied by oliguria, tinnitus, aching of the back and knees, pale tongue with whitish slippery coating and weak pulse
     The Chinese term肾虚水泛证refers to the pathological change characterized by failure of qi transformation and overflow of water dampness due to deficiency and debilitation of kidney yang. In the current translation practice, the Chinese phrase水泛in this term is translated quite differently. For instance, in the WPRO Standard2, 肾虚水泛is rendered as “kidney deficiency with water flood”, in which the Chinese phrase水泛is translated as “water flood”, sounding quite literal. In the WFCMS Standard3, 肾虚水泛is rendered as “syndrome/pattern of kidney deficiency and water diffusion”, in which the Chinese phrase水泛is translated as “water diffusion”, obviously a liberal translation. In some English-Chinese dictionaries of TCM, 水泛is also translated as “edema”. Comparatively speaking, to render水泛as “water flood”, though sounding somewhat alienate, is a temporarily practical trial.
     肾经寒湿证kidney meridian cold-dampness pattern/syndrome: a pattern/syndrome attributed to deficiency of kidney yang with infusion of cold-dampness, and marked by feeling of heaviness, cold and pain in the lumbus and knees with limitation of movement, aversion to cold and cold limbs, white slimy tongue coating and soggy relaxed pulse
     The Chinese concept经in肾经寒湿证is usually translated as meridian or channel, both of which are used quite frequently in the current translation practice. In the Standard Acupuncture Nomenclature5 issued by WHO Western Pacific Region in 1991, the English word “meridian” is adopted as the equivalence of经. However, in English language, “meridian” refers to an imaged line used in geographical studies. In TCM, 经is not an imagined line, it refers to the channel in the human body in which qi and blood are flowing all through the body. Obviously it is improper to translate经as “meridian”. That is why in the WHO Meeting on International Classification of Traditional Medicine held in Tokyo in 2010, the proposal to adopt the English word “channel” to translate the Chinese concept经was accepted.
     膀胱虚寒证bladder deficiency cold pattern/syndrome: a pattern/syndrome arising when kidney yang deficiency causes impaired bladder qi transformation, marked by frequent urination, incontinence of urine or dribbling of urine, cold feeling in the lower abdomen, whitish moist tongue coating and weak pulse
     The so-called虚寒in膀胱虚寒证refers to the cold caused by deficiency of yang that fails to warm the body. So in the term虚寒, the Chinese character虚describes the “deficiency” of yang, not the “deficiency” of cold. In order to clearly differentiate the logical relationship between虚and寒, it is better to translate虚寒into “cold due to yang deficiency”. However, such a translation will inevitably make the translation of the whole term too long to be practical. To make the translation accurate and concise, the ideal solution might be to use a hyphen to connect deficiency and cold. That is to say, 虚寒can be rendered as “deficiency-cold” rather than “deficiency cold”. The common clinical manifestations of this disorder still include aversion to cold, cold limbs, cold pain of lower abdomen, difficulty in urination, or nocturia, clear and profuse urine
     膀胱湿热证bladder dampness-heat pattern/syndrome: a pattern/syndrome attributed to dampness-heat attacking on and accumulating in the bladder, marked by frequency and urgency of urination, strangury, turbid urine or hematuria, reddened tongue with yellow slimy coating and rapid pulse
     This disorder is usually caused by invasion of dampness-heat into the bladder and accumulates in the bladder. Apart from the symptoms mentioned in the definition, the common clinical manifestations still include frequent urgent urination with burning pain and difficulty, or with bloody pus or stones, fever, thirst and slippery pulse, etc. In this definition, the English word “slimy” may be the translation of the Chinese concept腻which is also frequently translated as “greasy”. Comparatively speaking, “slimy” seems better than “greasy” in revealing the implied meaning of腻in Chinese language.
     热积膀胱证pattern/syndrome of heat accumulating in the bladder: a pattern/syndrome marked by distension and fullness of the lower abdomen, strangury, frequent urination and fever without chills
     The Chinese character积in热积膀胱证is usually translated as “accumulation” which is also adopted in the WPRO Standard. If “pattern/ syndrome of heat accumulation in the bladder” is changed into “pattern/syndrome of bladder heat accumulation”, it may look more concise. This disorder is caused by accumulation of pathogenic heat in the bladder. The common clinical manifestations include burning sensation and pain in urination, fever, thirst, reddened tongue with yellow coating, strong and rapid pulse, etc.

  
References
1. Shandong College of Traditional Chinese Medicine, Hebei Medical Collge. Elucidation of and comments on Plain Conversation and Plain Conversation[M]. Beijing: People’s Medical Publishing House, 1982.
2. World Health Organization Western Pacific Region. WHO international standard terminologies on traditional medicine in the Western Pacific Region. 2007.
3. Li ZJ. International standard Chinese-English basic nomenclature of Chinese medicine[M]. Beijing: People’s Medical Publishing House, 2008. Chinese-English.
4. Li ZG. International standardization of English translation of traditional Chinese medicine: study of theory, summarization of practice and exploration of methods[M]. Shanghai: Shanghai Scientific and Technical Publishers, 2008. Chinese.
5. A proposed standard international acupuncture nomenclature: report of a WHO Scientific Group. WHO Geneva. 1991.
  
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